Request counselling

For appointment inquiries and bookings, please complete the form below. For more information about our counselling, click here.

Referral is for...

Myself

My child

A student

Someone I'm supporting

Your details:

First name

Last name

Email*

Phone

Their details:

Their name

Date of birth

Gender

Ethnicity

Address

Context

Brief description of the situation including physical, emotional, & psychological. *

Do the symptoms relate to a mental health condition?

Yes

Please provide details (formally diagnosed, recommended treatment - completed, abandoned or ongoing – etc)

Do the symptoms relate to past traumatic experiences?

Yes

If yes, please provide details (since when, protective factors and triggers, past engagement with support due to this and what happened - completed, abandoned or ongoing – etc)

Is the person wanting counselling presenting with increased risk of suicide?

Yes

Please provide details (suicidal ideation, suicidal attempts, support network, safety plan)

Special requirements of the person wanting counselling e.g., gender of counsellor, location for counselling, diverse needs (cultural – Māori, Pasifika, immigrant; LGBTQ+)

Funding type

Would you be open to working with a student counsellor?

Yes

Our student counsellors are in the final stages of their training and work under professional supervision. Sessions are available at a reduced cost. Many clients find this a rewarding and supportive experience.

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